New Study: Smoking & Depression

New Study: Smoking & Depression

CHICAGO (AP) - A new study suggests smoking may be a cause of depression in teen-agers, contradicting the
current thinking that says depressed people may smoke to feel better.

The study found that teens who smoked were about four times more likely to develop highly depressed symptoms
during a year's time.

The researchers speculated that nicotine or other smoking byproducts may have a depressive effect on the
central nervous system.

The study adds to a growing body of conflicting research on links between tobacco and the mind.

``The thing that bolsters the idea is that there is evidence that anti-depressant drugs are helpful in
treating nicotine addiction,'' said Dr. Elizabeth Goodman, an adolescent-medicine specialist at Children's Hospital Medical Center of Cincinnati
who led the study.

The study appears in the October issue of Pediatrics, the monthly journal of the American Academy of
Pediatrics.

Other researchers have linked teen smoking with suicide, and smoking with depression in adults, but they
disagree over whether tobacco use is a cause or merely a result of a depressed state.

Most people think that those who tend to be depressed ``self-medicate by smoking. This is probably not the
case,'' said Naomi Breslau, director of research at Henry Ford Health Systems in Detroit.

Breslau's own research also has suggested tobacco may somehow contribute to depression. She said that
while the new findings do not prove smoking is a cause, they strongly support that theory.

``They find absolutely no evidence that depressive symptoms per se increase the risk for smoking,''
she said. ``They do find very clear evidence in the other direction.''

She added: ``It's just one more adverse effect of smoking on health.''

The study relied not on doctors' diagnoses but on teen-agers' reports of having symptoms suggestive of
depression.

The study analyzed data from teens questioned in 1995 and 1996 in a national study on adolescent health. It
included 8,704 teens who were not initially depressed and 6,947 teens who were not initially smokers.

Evidence suggesting depression was a cause rather than a result of smoking evaporated when the researchers
took into account other factors that may have prompted the teens to start smoking, such as friends' use of tobacco and poor grades.

Current smokers included those who smoked as little as one cigarette in the previous month and those who
smoked a pack a day or more. The researchers did not examine whether teens who smoked the most were the most likely to develop depression, but some of their
other findings suggest that may have been the case.

After a year's time, 4.8 percent of the nonsmokers had developed depressed symptoms compared with 12
percent of those who initially smoked at least a pack a day.

Linda Pederson, an epidemiologist at the Centers for Disease Control and Prevention's office on smoking
and health, said the study was well-done, larger and more nationally representative than previous research that reached similar conclusions.

This Link is to the text the full study in October edition of Pediatrics. Right now the link is so busy that you'll probably not be able to get
through. Tomorrow it should be easier. Please note that many medical journals make the text of their current articles available on-line for a limited time
and then remove them. Zep

SMOKING may be a major cause of mental illness as well as lung cancer and heart disease, research has found.

Evidence in the US suggests that tobacco can contribute to panic attacks, anxiety problems and schizophrenia. While it has long been known that mentally ill
people, such as those suffering from schizophrenia, are more likely to smoke, this has usually been thought to be a consequence rather than a cause of their
condition.

Jeffrey Johnson, of New York Psychiatric Institute, found that people who smoke a packet of cigarettes a day at the age of 16 are 16 times more likely to
develop panic disorders, seven times more likely to become agoraphobic and five times more likely to develop generalised anxiety disorder than non-smoking
peers.

MUMBAI: Lighting up a fag could, quite literally, drive you to despair. Smoking could be a cause of depression,
anxiety, panic attacks and perhaps even schizophrenia, reveals recent research.

Identifying tobacco as a potential cause of depression goes against conventional wisdom. "I actually feel that lighting up
relieves my blues,'' said Deepak Sood, a college student who smokes a pack a day.

Cashing in on this popular perception, the tobacco industry routinely markets its products as something that will lift your spirits and soothe
frazzled nerves.

However, experts now are increasingly saying that the short-term feel-good state is misleading since nicotine could well be insidiously
damaging the central nervous system, increasing the risk of mental illness.

The new findings are somewhat heretical because they go against not only popular perceptions but also against common medical beliefs.

In the past, whenever a strong correlation between tobacco and depression was observed, it was concluded that the illness preceded the
addiction. So the typical explanation for why a large number of depressed people smoked was that the depression came first, and it drove people to light up
so that they could alleviate and self-medicate their symptoms.

But the new studies, which are large and very well done by most experts' accounts, indicate that smoking is the cause of
depression.

One of the more important studies looked at over eight thousand teenagers who were not depressed to begin with. Crucially, the teenagers who
smoked were four times are more likely to develop depression than their non-smoking peers.

Similar research with adults showed that a history of daily smoking roughly doubled the risk of major depression.

Not all are happy with the new and somewhat frightening results, and they caution against jumping to premature conclusions. "It is
disturbing to find that smoking often comes before depression,'' concedes an executive with one of India's leading tobacco companies.

"But this does not prove that smoking is the culprit.'' He suggests that there could be other factors, such as genetic
proclivities, that could explain why the people who are likely to be easily addicted to nicotine are also likely to become depressed.

Public health experts agree that the new research, while promising, needs more follow-up. They stress that followup is especially important in
India, where mental diseases are taking an increasing toll.

"Cancer, heart disease, birth defects, high blood pressure-we knew about these physical perils of smoking,'' said Prakash Gupta
of the Tata Institute of Fundamental Research. "But now we have insights on how smoking adversely affects even mental health.''

In some ways I am happy to read this as it confirms my personal suspicion, that
smoking does indeed aid in the cause of depression (if 'aid' can be considered the correct word!).

I can attest to the fact that I have suffered from a low-level depression for many
years (as diagnosed by my GP) and that, since I have stopped smoking I have suffered far less depressive moods. True depression is the suppression of
one's emotions and a feeling of 'Who cares about anything!'.

Over the last six weeks I have felt far more emotion and have had many moments where
I have expressed myself in a joyous nature. In fact, I now feel as I wanted to when I previously unsuccessfully tried anti-depressants.

To be honest, this happening is a real revelation to me as I didn't expect it to
happen at this level, and I am so pleased it has. It's one of the main reasons I personally find it easy to feel that I will never take another
puff!

Which came first the chicken or the egg? Research in this area is still in its infancy, Bob, and the latest study results seem to have created
more questions than answers. No doubt that we're each a bit different. Do a certain percentage of smokers pay a mental health price by becoming dependent
upon the almost constant and unnaturally high levels of dopamine output achieved in their brain's reward pathways by smoking nicotine? I don't know.
What I do know is that the wonderful sense of calmness that evolves and emerges from this temporary period of adjustment called quitting is utterly amazing and
I refuse to go back. I still feel like I'm on vacation! To keep my addiction to nicotine under arrest isn't work at all. It's simply a matter of
never allowing myself to forget that I can NEVER TAKE ANOTHER PUFF! John

Nicotine is a neuroteratogen that targets synaptic function during critical developmental stages and recent studies indicate that CNS vulnerability extends
into adolescence, the age at which smoking typically commences. We administered nicotine to adolescent rats via continuous minipump infusions from PN30 to
PN47.5, using 6 mg/kg/day, a dose rate that replicates the plasma nicotine levels found in smokers, and examined 5HT receptors and related cell signaling
during nicotine administration (PN45) and in the post-treatment period (PN50, 60, 75).

Adolescent nicotine decreased 5HT(2) receptor binding in brain regions containing 5HT projections (hippocampus and cerebral
cortex), with selectivity for females in the cerebral cortex; regions containing 5HT cell bodies showed either an increase (midbrain in
males) or no change (brainstem). In contrast, there were no significant changes in 5HT(1A) receptors; however, the ability of the receptors to signal
through adenylyl cyclase (AC) showed a switch from stimulatory to inhibitory effects in females during the post-treatment period. There were also transient
alterations in AC responses to beta-adrenergic receptor stimulation, as well as pronounced induction of the AC response to the non-receptor-mediated
stimulant, forskolin. Our results indicate that adolescent nicotine exposure alters the concentrations and functions of
postsynaptic 5HT receptors in a manner commensurate with impaired 5HT synaptic function.

The direction of change, emergence of defects after the cessation of nicotine administration, and sex-preference for effects
in females, all support a relationship of impaired 5HT function to the higher incidence of depression seen in adolescent smokers.

Serotonin (5-hydorxytryptamine or 5-HT) is a neurotransmitter that is believed play a significant role in depression.
Serotonin is synthesized from the amino acid L-tryptophan in brain neurons and stored in vesicles. In addition to depression, serotonin is thought to
function in behavior, appetite control, muscle contraction, sleep, mood, and many other areas (nt in 90's). There are over twenty-four antidepressants
on the market today that are designed to treat depression based on the hypothesis that low levels of serotonin are to blame. Drugs currently being used
to treat depression are aimed at increasing the level of serotonin in the brain so that normal brain functions can occur.

A major factor in understanding the role serotonin has in depression is the recent advance made in understanding the role of various serotonin receptor
sites. There are four types of receptors for serotonin: 5-HT1, 5-HT2, 5-HT3, and 5-HT4. The function of each subtype has not been identified or
differentiated and is currently being researched and investigated. http://www.cem.msu.edu/~cem181fp/depression/SERO.htm

Department of Pharmacology, The George Washington University Medical Center, Washington, DC 20037, USA.

We sought to investigate the effect of nicotine exposure (chronic and acute) on serotonin transporter (SERT) activity in two regions of the brain important
for behavioral effects of nicotine. We first looked at the effects of chronic nicotine exposure (0.7 mg/kg nicotine, twice a day for 10 days) on [(3)H]5-HT
uptake in prefrontal cortex (PFC) and hippocampus of rats. A significant increase in [(3)H]5-HT uptake was observed in synaptosomes prepared from both
regions. To rule out the possibility that the increases were due to the last injection given, in a separate set of experiments a single injection of
nicotine was administered the evening before sacrifice. No change in uptake occurred in either region, suggesting that the increases in uptake caused by
nicotine was an effect of chronic exposure and not to an acute treatment. SERT binding studies, using prefrontocortical or hippocampal membrane
preparations, revealed that chronic nicotine exposure significantly increased B(max) which correlated to an increase in SERT density.

Lastly, we looked at the short-term effect of nicotine on [(3)H]5-HT uptake. Rats received a single nicotine injection 15-75 min before sacrifice. PFC
synaptosomes displayed a time-dependent increase in uptake, whereas hippocampal synaptosomes showed an increase at only one time point.

As this new December 2003 study suggests, science is still in the very very early stages of finding and putting together the pieces of the
nicotine-serotonin mood puzzle. To deprive nicotine's two-hour chemical half-life from having any determining factor in cycling of serotonin flow in
your brain is as simple as no nicotine today! No crave episode is longer than 3 minutes but time distortion is currently believed to be an almost
universial recovery symptom so be sure and look at a clock. The next few minutes are all that matter and each is entirely doable! John

Tenaged
girls suffer depression at almost twice the rate as boys, and teen smokers are more likely to be depressed than their non-smoking peers, according to a study by Dr. Bonnie Leadbeater (psychology)
published in the International Journal for Behavioural Development.

The study used survey data from 1,322 Canadian adolescents aged 12 to 19 who participated in a four-year National Population Health Survey in the late 1990s.

Almost 10 per cent of teen girls and three to five per cent of boys reported a major depressive episode each year.

"Depression in teens can be related to other problems such as eating disorders, substance abuse,
early pregnancy, and difficulties in school and personal relationships," says Leadbeater.

"The early teenage years are a critical time for identifying and treating young people, and
especially young women, who may be at risk," she says. Subjects who were 12 and 13 at the onset of the survey showed an increased rate of depressive
symptoms over the four-year-period of the study.

Leadbeater's study also looked into risk factors for teen depression such as obesity, physical
activity, lack of social support and smoking habits. These factors were not gender-specific in triggering depression. For both sexes, smoking and social
support were the strongest predictors for depresson over time.

Surprisingly, says Leadbeater, high body mass index is not a reliable sign of risk for depression.
"It may be that subjective perceptions of appearance are more important than actual body weight," she says.

The study found a decisive link between smoking and depression. Smokers are 40 per cent more likely to
experience a major depressive episode than non-smoking teens.

"It may be that adolescents who are already vulnerable to depression because of family history or
other stresses are more likely to begin smoking and become addicted," suggests Leadbeater. "Perhaps vulnerable teens are more likely to take up
smoking because of that short-lived feeling of well-being induced by cigarettes."

I would never have considered myself depressed, but the joy I feel everyday as a non smoker leads me to believe that perhaps I was depressed as a smoker. I
had no passion for life, no goals and no serious ambition. Since quitting a month ago, I seem to notice the beauty of the world more than I ever did, am I
just imagining things or could it be true that smoking is the cause of depression????

BACKGROUND: Recent research has demonstrated that smokers are at an elevated risk for psychiatric disorders. This study
extends the enquiry by examining: (1) the specificity of the psychiatric sequelae of smoking; and (2) the variability in the likelihood of these sequelae
by proximity and intensity of smoking.

METHOD: Data come from the National Comorbidity Survey (NCS), a representative sample of the US population 15-54 years of age. The Smoking Supplement was
administered to a representative subset of 4414 respondents. A modified World Health Organization-Composite International Diagnostic Interview was used to
measure DSM-III-R disorders. Survival analysis with smoking variables as time-dependent covariates was used to predict the subsequent onset of specific
psychiatric disorders.

RESULTS: The estimated effects of daily smoking varied across disorders. In the case of mood disorders, daily smoking
predicted subsequent onset, with no variation between current versus past smokers or by smoking intensity. In the case of panic disorder
and agoraphobia, current but not past smoking predicted subsequent onset; furthermore, the risk of these disorders in past smokers decreased with
increasing time since quitting. In the case of substance use disorders, current but not past smoking predicted subsequent onset, with no variation by time
since quitting or smoking intensity.

CONCLUSIONS: The data suggest that smoking cessation programmes would not prevent the onset of mood disorder, as ex-smokers do not
differ from current smokers in their risk for these disorders. In comparison, daily smoking might be a causal factor in panic disorder and agoraphobia,
conditions that might be preventable by smoking cessation. Additionally, current smoking might serve as a marker for targeting
interventions to prevent alcohol and drug disorders.

Im bumping this one up for everyone. I have read a lot of strings latley with people talking about this (me included) and just came across this one and
thought it was a great string.. hope no one minds..

Backgroung A link between cigarette smoking and suicidal
behavior has been reported in clinical and epidemiological studies.

Objective To examine the association between smoking and
suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal
behaviors is taken into account.

Design A longitudinal study of young adults interviewed
initially in 1989, with repeated assessments over a 10-year follow-up

Setting and Participants The sample was selected from a large
health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3,
5, and 10 years after baseline) exceeded 91%.

Main Outcome Measures Relative risk of occurrence of suicidal
behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating
equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each
reassessment.

Conclusions The biological explanation of the finding that
current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in
central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed
cautiously.

Author Affiliations: Department of Epidemiology (Dr Breslau) and Office of the
Dean (Dr Davis), College of Human Medicine, Michigan State University, East Lansing; Department of Biostatistics and Research Epidemiology (Drs Schultz and
Peterson) and Center for Health Promotion and Disease Prevention (Dr Johnson), Henry Ford Health Systems, Detroit, Mich.

CURRENT DAILY SMOKING MAY BE ASSOCIATED WITH INCREASED
RISK FOR SUICIDAL THOUGHTS AND ATTEMPTS

CHICAGO-Suicidal thoughts or attempts are associated with daily smoking in current smokers, but not former smokers, according to an article in the
Archives of General Psychiatry, one of the JAMA/Archives journals.

"A link between cigarette smoking and suicide has been reported in epidemiological investigations since the 1970s," according to background
information in the article. However, these interpretations have been subject to controversy. It is believed that depression may result in part from smoking
and should not be controlled in analysis of this relationship. However, it's also been reported that symptoms of depression in adolescents predicts their
starting smoking and that major depression leads to an increased risk for regular smoking and dependence; therefore, a history of depression must be
considered when examining suicide in smokers.

Naomi Breslau, Ph.D., from Michigan State University, East Lansing, and colleagues examined the association between cigarette smoking and suicidal
thoughts and attempts. Participants aged 21 to 30 years were interviewed in 1989 and completed follow-up interviews in 1992, 1994, and 1999 - 2001. At each
assessment, they were asked about lifetime smoking history, whether they were current daily smokers or had been in the past, and psychiatric disorders.
Nearly nine hundred people completed all three investigations.

During the ten-year follow-up, nineteen participants attempted suicide, while 130 reported having suicidal thoughts. The researchers found that current
daily smoking, but not past smoking, as reported at the beginning of each of the assessments, predicted the subsequent occurrence of suicidal thoughts or
attempt. These findings remained when adjusted statistically for prior depression, substance use disorders, prior psychiatric disorders and prior suicidal
disposition. Rates of suicidal behavior were also higher in those experiencing depression at the start of each follow-up period.

"The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear," the authors
conclude.
(Arch Gen Psychiatry. 2005;62:328-334. Available post-embargo at
archgenpsychiatry.com)

Editor's Note: This research was supported by a grant from the National Institute of Mental Health, Rockville, Md.

These articles are a real eye-opener! While I had chronic depression for many, many years
prior to taking up smoking, the very worst years for me, psychologically, coincided with the years I was smoking.

Another reason for me to have hope for the days to come, once my brain and body have
adjusted to freedom from nicotine.

BACKGROUND: Comorbidity of suicidal behavior with various risk factors has been reported. This study examines the combined effect and the interactions of
the most prominent risk factors in hospitalized suicide attempters.

METHOD: Seventy-six successive hospitalized suicide attempters and 76 matched control subjects, 9 to 20 years old, were subjected to Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Axis I and Axis II diagnoses and were interviewed for the use of licit and illicit substances. Also,
18 control subjects with the same psychiatric disorders diagnosed in the attempters were examined. Logistic regression analysis was applied to determine the
independent effect of the risk factors to suicide attempts.

RESULTS: The findings showed an 18-fold greater frequency of psychiatric disorders, a 14-fold greater frequency of other conditions that may be a focus of
clinical attention (mainly relational problems), a 9.7-fold greater frequency of smoking, and a 4.7-fold greater frequency of
psychosocial and environmental problems in the attempters than in the control subjects. The independent association of these factors with increased suicide
risk persisted after adjusting for the effect of other factors.

To me all this just makes intuitive sense. I've found that I'm less depressed after 5 weeks nicotine free. It seems that it's more than just the
easier breathing and less panic and hyperventilation. I simply feel more calm than I did when I used to modify my mood with 40 cigarettes a day. Just makes
sense that my normal undrugged brain chemistry would function more smoothly.

I heard this quote I think makes a lot of sense: "The cause of disease is not the lack of drugs". We tend as humans to think that there's always
something wrong that needs fixing. Maybe it's our attempts to always be fixing what may just already be fine that cause most of our problems.

Declaration of interest: J.P., L.W., F.J. and M.B. have received research support from an unrestricted educational grant from Eli Lilly. Funding detailed in

Abstract

Background: Smoking is disproportionately prevalent among people with psychiatric illness.

Aims: To investigate smoking as a risk factor for major depressive disorder.

Method: A population-based sample of women was studied using case-control and retrospective cohort study designs. Exposure to smoking was self-reported, and
major depressive disorder diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP).

Results: Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder
(age-adjusted odds ratio (OR)=1.46, 95% CI 1.03-2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers
(>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de
novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI
1.02-3.69); this was not explained by physical activity or alcohol consumption.

Conclusions: Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.

"It is becoming increasingly clear that smoking is not innocuous to mental health, and may in fact aggravate mental illness or contribute to its onset.
On a neurobiological level, this may be related to the impact of nicotine on monoamine neurotransmitter regulation, including dopamine, via the diffuse
cholinergic pathways. This may underlie the circadian dysrhythmicity and hedonic dysregulation in smokers, and may predispose to the development of mood
disorders. Smoking also has other systemic and metabolic consequences that may likewise increase this vulnerability."

"There is already evidence that smoking is a risk factor for depression. Association data from cross-sectional studies, support evidence from
prospective studies to suggest that smoking pre-dates the onset of depression. However, there is only limited longitudinal data in the existing literature,
and most longitudinal studies have involved time frames under 2 years, which may not be adequate to demonstrate the insidious effects of nicotine
dependence."

I just have to add, from my personal experience, that the chronological order in my own case was as follows:

1) I was an active, healthy teenager who started smoking at 17 years old

2) heart palpitations, general anxiety and panic attacks began within months of starting to smoke

3) depression set in by 18 years old, in response to having to cope with distressing physical changes to my body that I believe now (but did not know
at the time) were brought on by smoking

4) I kept smoking; lived with chronic low-grade depression. Except for smoke-free pregnancies 15 or so years later, anxiety and palpitations were a
part of life for 25 years

5) I quit smoking at 42 years old

6) palpitations and anxiety reduced to negligible almost immediately

7) depression lifted within months

8)I have had no panic attacks since quitting smoking, for almost seven months, and counting...

I am convinced that cigarette-smoking caused my heart and anxiety symptoms. In my own case, mild depression was most certainly a response to my
having to cope with distressing physical changes that I firmly believe were brought on by smoking.

Ilona- I always love your posts. The follow ups in this thread are good too. I got that I started smoking and drinking to a great extent to rebel against what
I considered the puritannical and uptight mores of my parents (It was the '70's). Smoking and drinking were about breaking free. Maintaining those
habits had almost a religious fervor to it. Never again would I be a "goody two-shoes". I wanted to be cool like Humphrey Bogart.

In quitting smoking, I had to realize that smoking was originally and continued to be a compensation for an insecure self image left over from adolescence. I
also got that the physical addiction was far less of a problem than the psychological attraction which still messes with me on occasion. (That's why
WhyQuit is so helpful).